Engel P, Marx A, Müller-Hermelink H K
Department of Pathology, County Hospital Roskilde, Denmark.
Pathol Res Pract. 1999;195(8):565-70. doi: 10.1016/S0344-0338(99)80006-5.
Histological slides of 213 thymic tumours were reviewed twice and classified according to Kirchner and Müller-Hermelink into 122 thymomas (syn. organotypic thymic epithelial tumours (TET)), 58 thymic carcinomas (syn. non-organotypic TET) and 16 lymphomas. Tumour heterogeneity (i.e. features of two subtypes in one tumour) appeared in 38% of the organotypic TET. The overall diagnostic correspondence between the reviews of the 122 organotypic TET was 48%. By reducing the five diagnostic groups to three: organotypic TET benign (medullary and mixed thymomas), organotypic TET low-grade (organoid and cortical thymomas and well-differentiated thymic carcinoma (WDTC)) and non-organotypic TET (usually high-grade thymic carcinomas), and minimising the effect of tumour heterogeneity in this way, the diagnostic correspondence increased to 82%. Correlating histological type with stage, we found that 80% of medullary and 87% of mixed thymomas were stage I, that 85% of cortical and 81% of WDTC were stage II or III, and that non-organotypic TET were stage II or III (86%) or stage IV (14%), respectively. It is suggested to report on the heterogeneity of a given case of thymic epithelial tumour in the pathology reports and give the approximate percentage of each component, telling the clinician which component may determine the prognosis.
对213例胸腺肿瘤的组织学切片进行了两次复查，并根据Kirchner和Müller-Hermelink的分类方法，将其分为122例胸腺瘤（同义词：器官样胸腺上皮肿瘤（TET））、58例胸腺癌（同义词：非器官样TET）和16例淋巴瘤。38%的器官样TET出现肿瘤异质性（即一个肿瘤中存在两种亚型的特征）。122例器官样TET两次复查的总体诊断符合率为48%。通过将五个诊断组简化为三个：良性器官样TET（髓质型和混合型胸腺瘤）、低级别器官样TET（类器官型和皮质型胸腺瘤以及高分化胸腺癌（WDTC））和非器官样TET（通常为高级别胸腺癌），并以此方式尽量减少肿瘤异质性的影响，诊断符合率提高到了82%。将组织学类型与分期相关联，我们发现80%的髓质型胸腺瘤和87%的混合型胸腺瘤为I期，85%的皮质型胸腺瘤和81%的WDTC为II期或III期，而非器官样TET分别为II期或III期（86%）或IV期（14%）。建议在病理报告中报告特定胸腺上皮肿瘤病例的异质性，并给出各成分的大致百分比，告知临床医生哪种成分可能决定预后。
